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Preventive Medicine HELP PLEASE

  1. #1
    Location
    Greeley, Colorado
    Posts
    2,045
    Question Preventive Medicine HELP PLEASE
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    I have an OB who is coding 9939X for the preventive visit AND 99401 for contraceptive counseling, infertility counseling, etc AT THE SAME VISIT. I told her she can't, she says she can...
    I need to hear from you all. I quoted CPT to her. She says "as I understand, counseling is for preventive stuff only". (Umm...Contraceptive counseling IS preventive...)

    HELP - AM I WRONG? I don't think I am.
    Lisa Bledsoe, CPC, CPMA

  2. #2
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    I agree with you, that is all part of why they come to the GYN for a yearly. As you stated CPT clearly states these are included in the E/M and to use 99401-99412 when the service is done at an encounter separate from the preventive medicine examination.

    When I put these codes thru my scrubber this is the response I get.

    "Unbundled E/M code An E/M service should not be billed on the same date as Hx Procedure [[99395],(PERIODIC PREVENTIVE MED EST PATIENT AGE 18-39YRS)] on Claim ID-Ext/Int Line ID [597094-1789843/1] unless circumstances warrant use of a modifier -25 or -57. "

    I have no idea when you would be able to justify a modifier in this case, I can't even imagine a scenario to fit this requirement.

    Laura, CPC, CEMC

  3. #3
    Location
    North Carolina
    Posts
    3,126
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    Yep...I agree with you Lisa...

    Excerpt from CPT Assistant (Dec 1994)

    The guidelines to this portion of Preventive Medicine Services were revised by eliminating the word "healthy", as was done in the previous guidelines for this section. Note, too, that the wording was changed to indicate that preventive medicine counseling and risk factor reduction interventions provided as a separate encounter are reported using codes 99401-99412. Codes 99381-99397 already include counseling/anticipatory guidance/risk factor reductions (ie, do not report codes 99401-99412 with codes 99381-99397.) Codes 99401-99412 are also not to be reported with E/M codes for services to patients with symptoms or established illness, since those E/M services already include counseling. For group counseling of patients with symptoms or established illness, use code 99078

    Excerpt from CPT Assistant (January 1998)

    Preventive Medicine Counseling

    Specific codes are available in the preventive medicine services section of CPT for reporting preventive medicine counseling. Codes from the 99401-99412 series are used to report counseling services provided to individuals at a separate encounter for the purpose of promoting health and preventing illness or injury.

    Preventive medicine counseling and risk factor reduction interventions provided as a separate encounter will vary with age and should address such issues as family problems, diet and exercise, substance abuse, sexual practices, injury prevention, dental health, and diagnostic and laboratory test results available at the time of the encounter.

    Separate subcategories of codes are available for reporting counseling and/or risk factor reduction intervention(s) provided to an individual or individuals in a group setting. These codes are time-based codes. The appropriate code is selected based on the approximate time spent providing the service. The extent of the counseling and/or risk factor reduction intervention must be documented in the medical record to qualify the service based on time.

    Counseling and/or risk factor reduction interventions which are provided at the time of the initial or periodic comprehensive preventive medicine examination are included in the preventive medicine E/M service and not reported separately.

    The counseling codes in the preventive medicine services section are not to be used to report counseling and risk factor reduction interventions provided to patients with symptoms or established illness. For counseling individual patients with symptoms or established illness, use the appropriate office, hospital, consultation or other evaluation and management categories of codes as appropriate. CPT code 99078 is available for reporting counseling of groups of patients with established illness.

  4. #4
    Location
    Greeley, Colorado
    Posts
    2,045
    Cool You guys rock!!
    Thank you both so much for relieving my stress and providing me with some more info to support my stance!!
    Lisa Bledsoe, CPC, CPMA

  5. #5
    Location
    Greeley, Colorado
    Posts
    2,045
    Cool You guys rock!!
    Thank you both so much for relieving my stress and providing me with some more info to support my stance!!
    Lisa Bledsoe, CPC, CPMA

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